The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis

Abstract

Background The plant Salvadora persica (miswak) has a long history of use in oral hygiene. Associations between the use of Salvadora persica and decreased oral bacteria numbers and plaque scores have been reported. This systematic review and meta-analysis assessed the ability of Salvadora persica mouthrinses to reduce plaque/cariogenic bacteria, in comparison to that of chlorhexidine and/or placebo rinses. Methods A comprehensive literature search for clinical trials reporting the use of Salvadora persica rinses as an antibacterial and/or antiplaque agent in comparison with chlorhexidine and/or placebo rinses was conducted, with no restriction to language. MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, Wiley Online Library, ScienceDirect, and Google Scholar databases were searched to include all articles published up to December 2018. Based on inclusion/exclusion criteria, data were extracted from the identified reports by two independent reviewers. The primary and secondary outcomes measured from the eligible studies were mean plaque scores and mean cariogenic bacterial counts, respectively. Risk of bias of these studies was assessed. A statistical test of homogeneity was used to determine if the results of the separate studies could be combined. Based on the chi-square test, an inconsistency coefficient was computed (I 2 statistic). Sensitivity analyses using subgroups and homogeneity evaluation were conducted. Results A total of 1135 potentially eligible articles were identified, of which 19 were eventually included in the qualitative analysis whereas 18 were included in the quantitative meta-analysis. The meta-analysis showed that Salvadora persica rinses exhibited strong antiplaque effects ( P < 0.00001, MD: 0.46, and 95% CI: 0.29 to 0.63). In addition, it had statistically significant anti-streptococcal ( P < 0.0001, MD: -1.42, and 95% CI: -2.08 to − 0.76) and anti-lactobacilli effects ( P < 0.00001, MD: -1.12, and 95% CI: -1.45 to − 0.79) when compared to placebo. However, its effects were inferior compared to those by chlorhexidine rinse ( P = 0.04, MD: 0.19, and 95% CI: 0.01 to 0.37). Subgroup analyses yielded results similar to those prior to subgrouping. Conclusion The use of Salvadora persica extract was associated with a significant reduction in the plaque score and cariogenic bacterial count. Although, this reduction was lower than that achieved with the gold standard chlorhexidine mouthwash, Salvadora persica -containing rinse could be considered as a suitable oral hygiene alternative for use in individuals of all ages, socioeconomic backgrounds, and health con...

The Effect of Oral Care with Miswak Versus Chlorhexidine on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial Study

“…There are many studies into the effect of miswak extract and chlorhexidine as well as other mouthwash solutions on the incidence of VAP and oral hygiene in ICU patients. Some of these reports have obtained results compatible with the present study, while some others have suggested findings contradictory to our research (40)(41)(42). Moeintaghavi et al addressed in vitro antimicrobial activity of miswak extract, chlorhexidine, and persica mouth-wash against major oral pathogens, and the results indicated that chlorhexidine involves more effective antibacterial activity than persica mouthwash and miswak at all tested concentrations.…”

Effect of antimicrobial activity of Teucrium polium on oral Streptococcus mutans: a randomized cross-over clinical trial study

“…Tooth decay is an epidemic problem in the world. While chemical mouthwashes have their own side effects such as discolorations of tongue and tooth surfaces, altered taste perception, soft tissue irritations and burning sensation [21], herbal mouthwashes can be an appropriate substitute for them [22,23,24]. Results of this study proved that a mouthwash containing T. polium can effectively decrease S. mutans population in the mouth, and this effect can last for at least three weeks after using the mouthwash.…”

The effect of antimicrobial activity of Teucrium Polium on Oral Streptococcus Mutans: a randomized cross-over clinical trial study

“…Tooth decay is an epidemic problem in the world. While the chemical mouthwashes have their own side effects, including discolorations of tongue and tooth surfaces, alteration in taste perception, soft tissue irritations and burning sensation [23], herbal mouthwashes seem to be an appropriate substitute [24][25][26]. Results of this study proved that a mouthwash containing T. polium can effectively decrease S. mutans population in the mouth, and this effect can last for at least three weeks after using the mouthwash.…”